POS1598-HPR TEACHING AND CLINICAL OUTCOMES OF A NOVEL FELLOWS’ INJECTION CLINIC
Authors: W. Martin, S. Albano-Aluquin, S. Banks, N. Olsen
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The skills of performing joint/periarticular injections by rheumatology fellows are learned during training but achieving the necessary level of expertise can be challenging if the rotations lack dedicated skills teaching. There is also a paucity of literature reporting how injection proficiency evolves and how the type and number of procedures can affect performance. <h3>Objectives</h3> To combat these issues and enhance fellow training and patient outcomes, we started an exclusive fellows' monthly injection clinic and assessed the learners' progress by analyzing their proficiency scores (PS) over time, and asking if these differ between size of joints and number of procedures done. We selected 10 or more procedures as the number needed to achieve higher expertise and determined the patient response (efficacy) and side effects as secondary outcomes. <h3>Methods</h3> The clinic is led by a single attending rheumatologist who demonstrates the proper technique prior to the encounter, supervises the procedure and provides feedback. Outcome measures include the procedure type classified as small/medium or large joint/periarticular structures. The PS was measured by the same teacher throughout and used a numerical scale of 1-3 defined as 1 – early, 2 – progressing, or 3 - advanced. Factors affecting proficiency score included preparation, technique, and cleanup. Efficacy was measured by successful aspiration and for steroid injections, by patient report of &gt;50% improvement in joint pain at the next follow-up visit. Patients were advised to call the clinic to report any adverse events. <h3>Results</h3> Thirteen clinics took place between December 2020-August 2022. Fellows performed an average of 4 procedures per clinic for a total of 52 procedures. PS were compared at initial (n=15) and last clinic encounter (n=17), and between large (n= 32) and small/medium joints/periarticular procedures (n=20). PS steadily increased over time with higher proficiency achieved by the 3<sup>rd</sup> or 4<sup>th</sup> clinic compared to the initial clinic [2(1-3) vs 1(1-2), p=0.018]. Fellows tended to achieve higher PS for large joint/periarticular procedures (hip and knee) compared to the more technically difficult small/medium joint/periarticular procedures (shoulder, feet and hands) [2[1-3) vs 1(1-2), p &lt; 0.0001]. We arbitrarily selected 10 or more procedures as the number needed to achieve higher expertise but found no difference in PS between performing &lt;10 versus &gt; 10 injections [2(1-3) vs 2(1-3), p= 0.35]. The procedures were highly effective and safe with favorable responses seen in 94.0% (49/52 procedures) with no reported side effects. <h3>Conclusion</h3> The longitudinal injection clinic demonstrated a steady improvement in proficiency among fellows while minimum number of procedures needed to attain expertise needs further studies. Our data can provide a useful template for designing a skills-based curriculum for rheumatology training programs. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Whitney Martin: None declared, Shirley Albano-Aluquin: None declared, Sharon Banks: None declared, Nancy Olsen Grant/research support from: Research grants from Amgen and UCB.